In most cases, the consumption of substances that alter psychological states or behavior is considered a normal pastime. However, substance abuse – illicit, prescriptive, or licit drugs – has been linked to multiple chronic behavioral and psychotic disorders (Blow & Barry, 2014). Substance abuse or drug abuse can cause adverse physiological, social, or psychological effects on users. Further, the use of certain prescriptive medications, e.g., Valium, is controlled due to the adverse effects of overdose. Research shows that recurrent use of licit substances, e.g., alcohol (depressant), can affect behavior and psychological functioning in the long-term (Blow & Barry, 2014). This research paper explores the definition/concept of substance use, criteria for diagnosis, history, causes, symptoms, different types, preventions, treatment plans, parenting strategies, and evidence-based therapies. It ends with a conclusion summarizing the major points of the paper.
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Substance Abuse: Concept or Definition
Substance-related disorders result from the problem use of drugs – whether illicit or not. The term substance abuse is defined as “a maladaptive pattern of drug use” that results in functional impairment or distress (Blow & Barry, 2014, p. 55). In this case, the use of substances persists despite its adverse social, occupational, or psychological consequences. Individuals with chronic absenteeism from school or work due to heavy alcohol use fit this definition. Engaging in binge drinking at a one-time party may not be considered substance abuse. Furthermore, habitual drinking of low or moderate quantities of alcohol may not amount to substance abuse provided it does not cause physiological or psychological impairment. Therefore, in defining substance abuse the quantity, drug type, or legal status do not matter. On the contrary, the gold standard for defining this disorder relates to whether the substance use results in psychological or physiological impairment. Its clinical manifestations include the individual fails repeatedly to meet his or her occupational or social obligations due to substance-related absenteeism, recurrent substance use, or chronic legal problems.
Criteria for Diagnosis
The ‘problem use’ of drugs results in substance-related problems. The DSM-IV criteria for a substance abuse diagnosis include hazardous use, substance-related social/interpersonal issues, neglect of occupational or family roles, and recurrent legal problems experienced within a 12-month period (Blow & Barry, 2014). Hazardous use arises when the abusive use persists despite the drug’s damaging physical or psychological effects. For example, a problem drinker will drive his/her car despite being cognitively impaired. The failure to meet occupational or family obligations arises from substance-related absenteeism or suspension. Legal problems affecting substance abusers may include arrests related to the disturbance of peace. On the other hand, social/interpersonal impairment due substance abuse may include family member assault or child abuse/neglect. Meeting one or more elements of the criteria is a threshold for a positive substance abuse diagnosis.
Studies indicate a historical prevalence of drug consumption, abuse, and addiction by working adults (Kitterlin, Moll, & Moreno, 2015). Alcohol abuse has been a widespread problem throughout history. The availability of more powerful drugs, such as cocaine and marijuana, by mid-20th century brought to light the issue of substance abuse by the Baby Boomer Generation (Blow & Barry, 2014). Work-related accidents, chronic absenteeism, substance dependency, and mental health problems were some of the effects of the increasing problem of substance abuse. According to Kitterlin et al. (2015), in 2015, one sixth of the American workers in the restaurant industry indicated using illicit drugs, including hallucinogens, crack, and hashish. Substance abuse became a diagnosable disorder under the DSM-IV of 1994. The disorder was associated with continued substance use despite apparent harm to the user. The DSM-IV was replaced by the DSM-V, which recognizes six substance-related disorders, including alcohol use disorder, tobacco use disorder, and cannabis use disorder.
Substance abuse disorder develops when there is repeated intoxication from alcohol and other psychoactive substances. It is characterized by continued use despite the knowledge of its adverse effects on one’s social and psychological functioning. Rowe and Liddle (2003) link the initiation and exacerbation of substance use to a host of family life and relationship factors. For adolescents, relationship factors, including strained parent-teen relationship, increase the risk of substance use. Further, parenting factors, such as “low monitoring, ineffective discipline, and poor communication”, correlate with the onset of the drug problem in adolescents (Rowe & Liddle, 2003, p. 108). Other family-related etiologies, such as strong parental disapproval, cause a protective influence on adolescent substance abuse. For adults, marital problems and poor communication patterns predict substance abuse initiation and escalation (Rowe & Liddle, 2003).
Substance abuse disorder involves various clinical manifestations that differ in severity depending on the drug being used. The DSM-V criteria for alcohol use disorder (AUD) identify 11 key symptoms. The identification of three, four, and six of these symptoms is a positive diagnosis for mild, moderate, and severe AUD, respectively (Blow & Barry, 2014). The AUD symptoms include the inadvertent consumption of large quantities of alcohol, unsuccessful attempts to stop drinking, a strong craving for alcoholic drinks, and persistent efforts to obtain/use alcohol (Blow & Barry, 2014). The recurrent use may result in the neglect of occupational or family roles.
The continued use of alcohol despite evident social harm is another symptom of the disorder. The AUD is also characterized by a persistent alcohol use even in risky situations, e.g., drink driving. Alcohol tolerance, which is marked by alcohol overdoses to attain intoxication, and withdrawal symptoms are the other clinical manifestations of AUD. The basic symptoms of substance abuse relate to impaired control, social/interpersonal distress, and hazardous use.
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As already stated, alcohol use disorder is a form of substance use disorder defined in the DSM-V criteria. It is defined as the at-risk use of alcohol in spite of evident adverse effects. AUD results from heavy drinking, i.e., the consumption of “five or more drinks on five or more days within a 30-day period” (Kitterlin et al., 2015, p. 811). The other types of the disorder include tobacco use disorder (heavy smoking), cannabis use disorder, stimulant use disorder (cocaine and amphetamines), hallucinogen use disorder, and opioid (morphine) use disorder. Alcohol and tobacco are the most abused substances because of their legal status. Other substances abused by adults include marijuana, crack, sedative drugs, etc. (Kitterlin et al., 2015). In the workplace, substance abuse is characterized by employee problems such as mental/physical impairment, social/legal issues, and elevated stress.
Because drug abuse involves family-related causes, preventive interventions focus on family-based therapies. Research evidence shows that family-based therapies are more effective in treating adolescent substance abuse and related problems than nonfamily interventions are (Rowe & Liddle, 2003). In particular, cognitive-behavioral therapy, when used with family support networks, has been shown to “engage and retain” abusing youth in therapy and reduce drug use in this population (Rowe & Liddle, 2003, p. 100). The prevention strategies adopted in the workplace include well-defined substance abuse policy, employee education, wellness programs, and drug testing (Kitterlin et al., 2015). These harm reduction strategies aim at preventing alcohol abuse among working adults by addressing risk factors such as workplace stress, conflicts, and financial problems.
The recommended guidelines for clinical encounters with substance abusers involve a greater focus on symptom severity in selecting appropriate interventions (Blow & Barry, 2014). In particular, screening for a concomitant use of prescription medications and alcohol would help identify the likely cause of substance preoccupation for appropriate interventions. The SBIRT model is a holistic approach to the prevention of alcohol and prescription drug abuse in social service environments (Blow & Barry, 2014). It entails “screening, brief intervention and referral to treatment” of substance abusers (Blow & Barry, 2014, p. 61). In this way, the model facilitates an early detection and treatment of the disorder.
The short-term and long-term goals of treatment plans for substance abusers include preventing relapse and achieving improved psychological and social outcomes. Evidence shows that brief interventions offered in clinical settings can lower drinking by up to 20% for problem drinkers, compared to alcohol users not receiving any intervention (Blow & Barry, 2014). Examples of the treatment methods include personalized feedback and 15-minute CBT sessions on alcohol use reduction. Family-based therapies have been used to improve the long-term treatment outcomes of substance abusers. An example is the Multisystemic therapy (MST), which demonstrated higher long-term retention rates than ‘treatment as usual’ methods (Rowe & Liddle, 2003). Further, this intensive sociological approach achieved significant reductions in substance use and recovery from the effects of alcohol and cannabis after a 7-month follow-up period.
Tips/Suggestions on How to Overcome the Disorder
The etiology of substance abuse disorder and related co-morbidities relate to the lack of awareness about the adverse effects of recurrent substance use. Suggested strategies for overcoming the disorder include preventive therapies for risky behavior change. Kitterlin et al. (2015) suggest a comprehensive workplace policy that is disseminated through firm website as a way of minimizing the modifiable risk factors. In addition, staff education on the effects of drug use on a person or a company can also change the behavior. The education should also include alternative interventions that produce same desired outcome as the abused drug. This approach resonates with the tenets of the behavioral choice theory because providing “alternate rewards” is considered an impetus for positive behavior change (Kitterlin et al., 2015, p. 814). The content should involve suggestions for alternate behaviors that produce the same outcomes. For instance, physical activity can improve psychological states and minimize anxiety as most drugs do. The information can be disseminated through flyers and posters in schools, workplaces, and public places.
Parenting behaviors determine adolescent change during an intervention. The parental behaviors that reduce treatment outcomes include negative affect and verbal abuse (Rowe & Liddle, 2003). On the other hand, positive parenting behaviors that can help an abusive adolescent minimize substance use in the course of therapy include “positive affect, monitoring and limit-setting, and commitment” (Rowe & Liddle, 2003, p. 105). This correlation augurs well with the foundations of family-based interventions, which emphasize on positive parenting practices. Relationship factors, such as poor parent-youth relationship, have been shown to contribute to a high risk of drug use among adolescents (Rowe & Liddle, 2003). Therefore, effective parenting skills for preventing adolescent drug use include monitoring, discipline, and enhanced communication. However, strong parental disapproval can lead to undetectable drug use problem.
Various family-based therapies have been used to treat substance abuse disorder. The multi-dimensional family therapy (MDFT) that treats abuse-related symptoms using a developmental approach reduced drug use by 27% in adolescents hooked to marijuana (Rowe & Liddle, 2003). Another evidence-based therapy is family support network (FSN), which when used with CBT, minimizes disorder symptoms in high-severity youthful populations. In contrast, the functional family therapy (FFT) focuses on changing the maladaptive family patterns causing adolescent substance abuse (Rowe & Liddle, 2003). It encompasses behavioral interventions that build positive behaviors and strengthen problem-solving capacities of parents and adolescents. The aim is to improve family functioning, which is a protective factor against substance abuse. Another treatment approach involves the SBIRT model. It entails comprehensive screening to determine symptom severity, followed by brief interventions to curb disorder progression to a dependence syndrome.
The primary etiology of substance abuse disorder is the recurrent use or overuse of alcohol and other psychoactive drugs. Its diagnosis is based on the continued use of a drug in spite of its adverse effects on one’s psychological and physiological functioning. The therapies and preventive interventions focus on minimizing the risk factors related to substance use initiation and exacerbation. The disorder’s clinical manifestations include hazardous use, chronic social/interpersonal problems, occupational/family role neglect, and recurrent legal problems. Thus, the adverse physiological, social, or psychological effects to users constitute the gold standard for substance abuse diagnosis in users.
Blow, F., & Barry, K. (2014). Substance misuse and abuse in older adults: What do we need to now to help? Journal of the American Society on Aging, 38(3), 53-67. doi: 10.1007/s11920-012-0292-9.
Kitterlin, M., Moll, L., & Moreno, G. (2015). Foodservice employee substance abuse: Is anyone getting the message? International Journal of Contemporary Hospitality Management, 27(5), 810-826. doi: 10.1108/IJCHM-11-2013-0522.
Rowe, C., & Liddle, H. (2003). Substance abuse. Journal of Marital and Family Therapy, 29(1), 97-120. doi: 10.1111/j.1752-0606.2003.tb00386.x.